This is an application for a K07 award for Dr. Larissa Meyer, a gynecologic oncologist at The University of Texas MD Anderson Cancer Center. Dr. Meyer is establishing herself as a young investigator in health services research of gynecologic malignancies. This K07 award will provide Dr. Meyer with the necessary protected research time and support to accomplish the following goals: 1) to gain experience with advanced analytic and statistical techniques utilizing large national databases; 2) to build decision analytc models; 3) to design and analyze studies with qualitative research methods; 4) to obtain practical hands on experience building tools for shared medical decision making; 5) to develop an independent research career in health services research. To achieve these goals, Dr. Meyer has assembled a mentoring team comprised of a primary mentor, Dr. Sharon Giordano, Chair of Health Services Research, who conducts analyses of large administrative databases, and two co-mentors: Dr. Scott Cantor, a clinical decision analyst who focuses on decision analyses in oncology; and Dr. Robert Volk, whose expertise in decision-making spans research on patients' preferences and values to applied studies in patient decision support and decision aids for promoting informed choice. Although it is well accepted that optimal therapy for advanced ovarian cancer remains a combination of tumor debulking surgery and platinum/taxane based chemotherapy, there is still an ongoing heated international debate focused on whether it is better to start with primary debulking surgery (PDS) or neoadjuvant chemotherapy (NAC). Dr. Meyer's research will focus on 1) building a decision analytic model that incorporates the best published evidence supplemented by primary analyses of outcomes with PDS or NAC in national databases and the high quality MD Anderson ovarian cancer database (Aim 1), and patient preferences and experiences (assessment of symptom burden) when starting treatment with primary debulking surgery or neoadjuvant chemotherapy (Aim 2). Aim 3 will entail the design and iterative testing of a shared medical decision tool prototype that combines predictive clinical factors with interactive values clarification methodology to support patients and physicians in the complex process of deciding on primary treatment for advanced ovarian cancer. This focused research and training plan will provide Dr. Meyer with the skills needed to impact women with gynecologic malignancies through meaningful, patient centered, health services research, and will form the basis for a prototype decision tool to test in a prospective, multi-site, randomized controlled trial for women with advanced ovarian cancer. This study will be proposed in an R01 grant application that will be submitted before the end of the career development award period.